MEDICARE: DONESHIA FIZER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	501043631105	OH
2	376J00000X	Homemaker	501043631105	OH
3	376K00000X	Nurse's Aide	50104631105	OH

General Provider Information

NPI Number	:	1629503743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONESHIA FIZER

Provider Business Mailing Address
First Line	:	4110 N LOCKWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1745
Country	:	US
Telephone Number	:	419-324-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 N LOCKWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1745
Country	:	US
Telephone Number	:	419-324-5595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	05/02/2017

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Directions to “ DONESHIA FIZER ” Practice Location

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